【摘要】 目的探讨高通量透析对维持性血液透析患者肾性贫血的防治作用及其机制。方法55例患者随机分为高通量透析组(HPD组)与常规血液透析组(CHD组),HPD组患者使用聚砜膜F60高通量透析器,CHD组患者使用低通量F6透析器治疗,检测首次透析前后两组患者血尿素氮穴BUN雪、肌酐穴Cr雪、K+、Na+、Cl-、Ca2+、P3-、甲状旁腺素穴PTH雪,以及透析前后血浆细胞因子(IL-1β、IL-6、IL-8、TNF-a)和透析开始20min后透析废液中上述细胞因子含量,动态观察并记录患者主诉,动态检测透析前后血红蛋白、红细胞压积,透析治疗1年后,复测并比较两组患者临床生化指标。结果①HPD组对PTH、P3-清除高于CHD组(P<0.05),透析1年后,HPD组血浆PTH、P3-水平明显低于CHD组(P<0.05)。②透析后即刻HPD组透析废液中细胞因子含量显著高于CHD组(P<0.05);透析治疗1年后HPD组血浆细胞因子水平呈下降趋势,但与治疗前比较,无统计学意义(P>0.05)。③透析后即刻,HPD组与CHD组血红蛋白、红细胞压积水平与透析前比较均呈上升趋势,但无统计学意义(P>0.05),两组间比较差异不显著;透析1年后,HPD组血红蛋白、红细胞压积水平较透析前水平变化差异显著(P<0.05),两组间比较显著升高(P<0.05)。结论HPD可改善维持性血液透析患者的肾性贫血,其机制与HPD能清除一些不易被CHD更多还原

【Abstract】 Objective To study the effect of high flux dialysis on maintenance hemodialysis patients with renal anemia and its mechanism. Methods A total of 55 hemodialysis patients were divided into two groups:high flux hemodialysis (HPD) group (n=30),treated with Fresenius F60 polysulfone hemofiltrater,kuf 40 ml/(mmHg·h);conventional hemodialysis (CHD) group (n=25),treated with Fresenius F6 polysulfone dialyzer,kuf 5.5 ml/(mmHg·h). At the initial treatment in HPD or CHD,pre and post treatment,all patients’ blood urea nitrogen(BUN),creatinine(Cr),K+,Na+,Cl-,Ca2+,P3-,parathyroid hormone(PTH) and Hb,hematocrit(Hct) were measured. At the same time,the levels of serum cytokine(LI-1β,LI-6,LI-8,TNF-α) was determined by radioimmunoassay,and the levels of cytokine in dialysate were also collected to measure.The symptoms of all patients were observed and recorded in group HPD and in group CHD. After one year, the levels of BUN,Cr,PTH,LI-1β,LI-6,LI-8,TNF-α,Hb,Hct were remeasured. Results ①The side-effects in HPD group were significantly lower than that in CHD group.②The clearance of serum P3-,PTH were significantly higher than that in CHD group(P<0.05).③The levels of dialysate cytokine in HPD group were higher than that in CHD group,but the levels of plasma cytokine in two groups were similar in one year.The serum levels of Hb,Hct were increased but cytokine,PTH were decreased in HPD group (P<0.05),while there were no significantly change in CHD group(P>0.05),and there were significantly difference between two groups. Conclusion HPD can effectively improve the renal anemia in patients with maintenance hemodialysis and its side-effects was much lower than that in CHD.The possible mechanism may be related with its clearance of the medium-molecular solute(PTH) and cytokine.更多还原